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I Should Be Doing More

As this pandemic began, like my colleagues, I scrambled to adjust my psychiatry practice. Each day was spent trialing various online video applications, googling “What is a virtual fax?” and adjusting to the startling visual of my aging face on Zoom. But all of this was the easy part.


A more difficult task was quieting the voice urging me to “Do more.” Watching reports of the growing pandemic, I thought of my medical school classmates in critical care or emergency medicine, many of whom still practiced in the early hot spot of New York City. As health care providers were lauded with cheers, banging pots and honking car horns, I felt guilty to be safe in my family bubble, treating patients from the security of my home office.


This feeling grew with the daily reports of looming mental health crises, including skyrocketing rates of anxiety, insomnia, depression and post-traumatic stress. I knew I was trained to address these issues with evidence-based treatments, but a one-on-one therapeutic relationship can be difficult for patients to find, and often limited by cost, availability, and stigma.


Patients arrive in my office (or on my screen, recently) after a lengthy and difficult journey through referrals, phone calls and insurance inquiries. When we first connect, they share their understandable frustration, and I can’t help but apologize for the limitations of my chosen field. I recognize we as providers are too few, often inaccessible, and, when available, frequently too costly to engage.


Finally, after months of grim news and contemplation, I sat down at my computer, took a deep breath, and started writing. This sounds like a simple step, but earlier trials triggered numerous limiting thoughts, including, “You are not a writer. Stay in your lane, stick to what you know.” But eventually, with a growing sense of urgency, I began to understand, "I have something unique to say."


In fact, we all do. We all curate the story of our lives, hewn from our memories, desires, and challenges. Rather than an exact replica of events, our narrative shifts with time and experience.


This is why I love my job. As a long-time fiction devotee, my sessions contain storytelling at its most profound. Patients offer their histories, woven throughout with their interpretations and assumptions. This is where we begin. Together, we revise this narrative, as I point out their patterns of resilience, their methods for survival, and help them find new, empowering ways to retell their story. After more than 10 years of practice, I remain grateful for their trust and candor.


Seeking to better understand the importance of his own life story, author Bruce Feiler wrote Life is in the Transitions after traveling throughout the country, collecting more than a thousand hours of interviews with people he met in all 50 states. Asking about the “transitions, disruptions, and reinventions of their lives…,” he labeled this exploration, “The Life Story Project.” It was prompted, in part, by his father’s surprising remission from severe depression when he began composing his autobiography. Reflecting on the insights gathered in these discussions, Mr. Feiler writes, “We all ache. We all hurt, suffer, and yearn.” And yet, importantly, he continues, “We all need to be the hero of our own story.”


I was drawn to this book in the setting of my own major life transitions: leaving the camaraderie of academic medicine to pursue a new path, the unexpected vulnerability of spinal surgery for a herniated disk, and, most painfully, the loss of one of my dearest friends to a brain tumor. It is one thing to help patients bear their waves of intense grief, and quite another to feel the aching lurch after a glance at the scarf my friend generously knitted for me as his health declined.


He is another reason I write, and I imagine he will emerge from time to time in future essays. A brilliant psychiatrist, father, husband, lover of opera and George Saunders, with the most amazing laugh. If we were in the same room, my focus narrowed to any topic that would evoke that beautiful sound. Though writing this brings tears, I trust that experiencing deep sadness can increase my empathy for my patients and loved ones, and I try to welcome it. Holding a place for those feelings, telling his story, sharing my reflections, reaching out to those I may never meet, this is one way I am trying to “do more.”


And so, I encourage all of you: Don’t silence your stories. They are intimately yours, and immeasurably powerful. You all have something unique to say, and the world will be better for having heard it.


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